Roadmap to implementing sustainability practices in healthcare

The impacts of climate change on health organizations need to be addressed to ensure resilience and continuity of health services. At the same time, it is important to consider health organizations' impacts on climate change through their energy use, water use, waste generation, and more. A scoping review was conducted by researchers to identify the barriers and enablers of implementing environmentally-sustainable practices in healthcare. Based on findings from this review, a roadmap was developed to support key stakeholders such as health practitioners and leaders. Below is an overview of this roadmap with key questions that should be considered at each step.

Step	Key objective(s)	Proposed considerations
Understand the geography, infrastructure, and policies	Identify whether the geographical infrastructure and/or policies are conducive to environmentally sustainable practices	Does the government monitor environmental indicators and is performance associated with incentives? How does the current infrastructure impact environmentally sustainable practices?
Assess and identify the top sustainability issues at the organizational level	Assess key practices (e.g. carbon footprint) at the organization Identify practices that contribute most negatively to the environment	What are the key environmental issues stemming from the organization’s practices? Which practices are resulting in the most waste, greenhouse gas emissions, water use, or energy use?
Develop a priority list	Identify two relevant metrics (e.g. impact and feasibility) to prioritize the organization’s environmental issues Plot the issues on the matrix to identify the ones that should be addressed first (i.e. those with the highest impact and feasibility)	What would be the impact of addressing each of these environmental issues (e.g. how much greenhouse gas emissions will be avoided by revising our supplier standards)? How feasible is it to implement change given the current context of the organization (e.g. budget, resources, policies, and agreements)?
Conduct a benchmarking exercise	Identify best practices in addressing the environmental issues prioritized in step 3 Identify how the concept of reduce, reuse, recycle, rethink, and research could be adopted	What have other healthcare settings done to address this environmental issue?Which practices were successful and/or cost-effective?
Obtain buy-in from key stakeholders	Identify which health professionals and stakeholders will be most involved in leading the change Communicate proposed changes and confirm priorities with identified stakeholders	Which health professions or stakeholders will be required to make this change possible? Do these stakeholders buy-in to the change or are there any concerns that should be addressed at the start?
Develop the vision and strategy	Develop and communicate a vision that resonates with key stakeholders and the proposed changes Develop and communicate a strategy in line with the vision all while considering concrete objectives, targets, and incentives	How could the proposed changes be captured in a vision that resonates with key stakeholders? What are the targets to be achieved? How will progress be monitored and rewarded?
Develop a roadmap	Develop a roadmap that outlines the key steps for achieving change Revise the roadmap based on inputs from key stakeholders responsible to implementing change	How will the strategy be actioned? How will the targets be achieved while ensuring that key stakeholders, including health professionals, have sufficient time to provide quality care? Who are the specific players to involve at each step?
Provide training	Provide training to all relevant stakeholders who may be involved in or affected by the proposed changes Outline the benefits of implementing new practices	How can training be tailored and delivered to improve overall knowledge related to environmental sustainability? How can the benefits of the proposed practices be communicated to all relevant staff members?
Conduct a pilot	Design and conduct a pilot project that allows the team to rectify issues encountered with the proposed roadmap	How can the proposed roadmap be revisited to address any issues encountered during the pilot project?
Scale	Scale new practices once the roadmap has been revised to include solutions for potential issues encountered during the pilot project	Which other units across the organization would benefit from such changes in practice? How can the tested roadmap be scaled across the organization (in one location or across a network of healthcare settings)?
Measure and refine	Measure and assess performance against established targets Continuously refine practices to ensure achievement of targets	How is the organization performing on key targets? How can practices be refined further to ensure target achievement?

W&W Sustainability Lead, Dr. Stephanie Hanna, discusses the barriers and enablers for implementing sustainable practices in healthcare.